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A Psychiatrist Explains The Difference Between The 2 Types Of Trauma

Sarah Regan
mbg Spirituality & Relationships Writer
By Sarah Regan
mbg Spirituality & Relationships Writer
Sarah Regan is a Spirituality & Relationships Writer, and a registered yoga instructor. She received her bachelor's in broadcasting and mass communication from SUNY Oswego, and lives in Buffalo, New York.
Image by Chelsea Victoria / Stocksy
February 14, 2020

As the zeitgeist moves toward healing, self-awareness, and emotional intelligence, "trauma" has become somewhat of a buzzword in the well-being world. We've talked with many doctors and experts about the implications a traumatic event can have on mental health and the best ways to heal (a conversation we had with Kelly Turner, Ph.D., and Lissa Rankin, M.D., can be found at the end of this article).

These conversations have taught us there are essentially two kinds of trauma: "Big T" and "little t." But what does that mean? We spoke with psychiatrist Stacy Cohen M.D., to get a better understanding of this terminology and why it's important to know the difference.

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The difference between "Big T" and "little t" trauma.

"Big T trauma" is more severe and comes from a life-threatening event, like sexual assault or physical abuse. "Little t trauma" is more subtle and personal, which Cohen says causes it to often be overlooked: "Maybe it's within the family, and one of the kids is put on a pedestal while the other is neglected over the years. Or maybe it's having a narcissistic parent."

Still, even if they're "little," these traumas can go on to have detrimental effects too, especially if they're recurring issues. "[Patients] come in saying, 'I had a perfect childhood and I have no trauma,'" Cohen adds, "and they learn over time that some of those family dynamics could have been quite traumatizing and put their body into a trauma response for years and years. So now, their amygdala is reacting inappropriately to fear because it's something that they never identified as a trauma."

Examples of "Big T trauma":
  • Sexual and/or physical assault
  • Witnessing a violent crime
  • Death of an immediate family member
  • A life-threatening car accident
Examples of "Little t trauma":
  • Recurring emotional abuse
  • A non-life-threatening accident
  • Childhood neglect
  • Prolonged harassment or bullying
  • A rough breakup
  • The death of a pet
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Why does it matter for healing?

"A lot of times," Cohen says, "we're redefining for patients what trauma actually is." So, once you understand what kind of trauma you're dealing with, you can begin taking steps to heal.

One common and proven method for working through trauma is EMDR, or eye movement desensitization and reprocessing. It's a method of rewiring the brain's trauma response through visual techniques, and over time, the brain learns to react to triggers appropriately instead of reliving the same emotional or somatic response they've always had.

Different forms of therapy can also be used in healing trauma, such as cognitive behavioral therapy, hypnotherapy, and psychodynamic therapy.

As far as lifestyle choices people can make when healing, Cohen stressed the importance of community. "In grief, say, losing a spouse, for example, meeting other people who have been through it and have risen and have continued live past that trauma is really helpful," she says. "Group therapy can also be really helpful, you know, just having that sense of community."

And, of course, self-care is an important factor in anyone's healing journey. "Adding self-care into their routine, and taking care of themselves—it's not selfish," Cohen says. "You have to put yourself first."

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Sarah Regan
Sarah Regan
mbg Spirituality & Relationships Writer

Sarah Regan is a Spirituality & Relationships Writer, as well as a registered yoga instructor. She received her bachelor's in broadcasting and mass communication from SUNY Oswego, and lives in Buffalo, New York.